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Chinese Medicine Treatment Plans for Primary and Secondary Amenorrhea

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There are two types of amenorrhea: primary and secondary. The failure to menstruate in a 16 year old or older female who has developed secondary sex characteristics or in a 14 year old or older female who has not developed secondary sex characteristics is classified as primary amenorrhea. Inexistent menstruation for either three cycles or six months or in a woman who has had regular menstruation is deemed secondary amenorrhea. Amenorrhea is normal when a woman is pregnant or when she is breast-feeding.

Careful diagnosis should be considered if an adolescent girl is suspected to suffer from amenorrhea. Adolescence is the transitional phase of a person in-between childhood and adulthood. Menstruation tends to be typically irregular during this stage, even occasionally missing menses for as long as six months.

Etiology and Pathology

Amenorrhea has an etiology and pathology that is quite complex. In Chinese medicine, it may be a type of strength or deficiency.

Strength Type

When an amenorrhea is due to a strength type, it is usually the result of Cold in the blood caused by blood stasis, blockage due to Phlegm-Dampness, or blood stasis with Qi stagnation. These conditions cause blockage of the Ren and Chong energy channels (Meridians) leading to amenorrhea.

Cold in Blood caused by Blood Stasis

In this condition, Blood can become inadequate during and after the period of menses or right after childbirth. Too much eating of raw and cold foods or exposure to water and cold in such conditions allows the pathogenic Cold to attack and remain in the Ren and Chong Meridians. Blood congeals as a result of the lodged Cold inducing stasis.

Phlegm-Dampness Accumulation

In obese people, Phlegm and Dampness are commonly abundant. These two conditions can also develop when the functions of the spleen are weakened. Phlegm and Dampness as well as Fats, usually block the Ren and Chong Meridians. When the meridians of the uterus are closed, amenorrhea develops.

Blood Stasis and Qi Stagnation

Passions, particularly longstanding rage or depression can cause internal injury to the heart. This may lead to blood stasis and Qi stagnation. When blockage arises in the Ren and Chong meridians, the flow of blood and Qi becomes blocked resulting in amenorrhea.

Deficiency Type

Commonly the result of Yin deficiency resulting in depletion of blood, blood and Qi deficiency, kidney and liver deficiency, deficiency-type amenorrhea, in turn, leads to blood and essence deficiency in the Ren and Chong Meridians. Menses then does not happen simply because there is no blood available for it to occur.

Kidney and Liver Insufficiency

In certain instances, prenatal development of the kidney is insufficient, causing the inadequacy and failure of kidney-Qi to flourish. Since Qi and kidney essence are inadequate, Liver-Blood is also inadequate and the Ren and Chong Meridians are poorly nourished and are unable to supply blood for menses. In some patients, Liver-Blood and kidney-essence deficiency can be caused by chronic illnesses affecting the kidney, too much excessive sexual activity, miscarriage, and multiple pregnancies. All these can result in the failure of the Ren and Chong Meridians to furnish blood for menses.

Blood and Qi Deficiency

Any one of the following may cause blood and Qi deficiency leading to a poorly functioning Ren and Chong Meridians:

• Excessive anxiety, grief, brooding, or fatigue that may harm the heart
• Improper diet
• Chronic weakness of the abdomen and spleen

Yin Deficiency Caused by Blood Depletion

This can be the result of excessive consumption of dry and spicy foods, Yin deficiency caused by too much blood loss, or constitutionally inadequate Yin can all cause the emptying of the sea of blood, and therefore, amenorrhea. Deficiency amenorrhea can also come about due to extreme chronic conditions that can deplete Yin and essence.

Clinical Manifestation

In certain occasions, amenorrhea can be connected to tuberculosis, galactorrhea, infertility, hirsutism, obesity, menopause, deformities or poor physical development. Patients having these conditions can manifest their own unique symptoms.

Herbal Medicine

The patient’s medical history is vitally important. In family member and in the patient, observe disorders such as congenital defects, or retarded physical development. Also, inquire about the use of contraceptives, tuberculosis, postpartum uterine bleeding, multiple endometrial curettage, pattern of menstruation, and delayed menarche.

The patient’s development of secondary sex characteristics, nutritional status, physical development and general condition should be evaluated during physical exam. See if associated conditions exist as well as any deformities or abnormalities of the patient’s internal genital organs.

Lab tests may include adrenal gland function tests, tests for thyroid hormone levels, ovarian hormone levels, formulas, pituitary function tests and ultrasonic B scanning tests. It may be proper to do tests specifically for ovarian and uterine functions. These may include ovarian stimulation test, cervical smear cytology, special x-ray studies, and diagnostic curettage.

Typically, if the menstrual flow of the patient has progressively lessened then stops or if the patient is past the normal age of menarche and the menses has stopped, and symptoms of deficiency show, then she has a deficiency type of amenorrhea. If the patient has had normal menses that suddenly stops, and she manifests symptoms of strength condition, her amenorrhea is deemed a strength type.

In treating amenorrhea, the key to effective treatment is to know whether the absence of menses is a deficiency or strength type. Knowing if it’s caused by some other illness is equally important. Usually, the basic plan of treatment is as follows: if the amenorrhea is a strength type, remove what is strong; if it is a deficiency type, restore what is deficient.

It is not proper, however, to restore very vigorously or apply indiscriminate purgation. The practitioner should see to it that the strong is not aggravated or that the deficiency gets worse. Also, the illness must be treated first if the amenorrhea is caused by some other illness.

The strength type of amenorrhea is less common the deficiency type.

Kidney and Liver Insufficiency

Main Symptoms: Either the menses show a progressive decrease in amount or menarche is delayed, ending eventually in amenorrhea. Moreover, the constitution of the body tends to be weak, manifesting in tinnitus, dizziness, and aching weakness in the knees and waist. The patient’s pulse is impeded and threadlike or weak and deep. The patient has also a pale red tongue with a slight coating.

Plan of Treatment: Nourish the liver and reinforce the kidney to normalize menstruation.

Treatment: Polygonum (heshouwo), spatholobus suberectus (jihsueteng), augmented with Kidney-Restoring Pill (Gui Shen Wan).

Blood and Qi Deficiency

Main Symptoms: Menstruation can become progressively longer with the menses being thin and light-colored, decreasing in amount until amenorrhea sets in. Other symptoms include anorexia with dull skin and hair, tired limbs and lassitude, heart palpitations with shortness of breath, and dizziness with blurry eyesight. The pulse is even and deep while the tongue is pale with thin or slight coating.

Plan of Treatment: Normalize menstruation and nourish blood and Qi.

Treatment is Ginseng Blood-Qi- Nourishing Decoction (Renshen Yang Rong Tang) that has the following composition: 6 g of glycyrrhiza (fried gancao), 8 g of cinnamomum (rougui), 12 g rehmannia, (shudihuang), 10 g peony (baishaoyao), 10 g angelica (danggui), 10 g schisandra (wuweihsi), 6 g citrus tengerina (chenpi), 10 g polygala (yuanzhi), 20 g poria (fuling), 12 g Atractylodes (baizhu), 20 g astralagus (huangqi), and 10 g panax (renshen).

Patients who occasionally suffer from amenorrhea include those who have experienced severe postpartum hemorrhage that’s accompanied by genital atrophy, low libido, axillary and vulvar hair loss, vaginal dryness, and lack of interest, as well as blood and Qi insufficiency symptoms. This is caused by emptiness of the Ren and Chong Merdians, kidney Qi deficiency, and blood and essence depletion.

Treatment may entail the use of Renshen Yang Rong Tang combined with 10 g Cervus nippon (lujiaoshuang), or certain restorative herbs. This remedy needs to be taken for a long period of time.

Yin Deficiency Resulting in Blood Depletion

Main Symptoms: Menses progressively decrease until there’s zero menstruation. Also, symptoms such as recurrent fever with hemoptysis or night sweats, fever with exhaustion, and hotness in the five centers may arise. The pulse is rapid and threadlike while the tongue is reddish with thin coating.

Plan of Treatment: Regulate menstruation, cool Heat, and nourish Yin.

Treatment: Prescription of Yin-Generating Liver-Opening (Yi Guan Jian), along with zhichiao, danshen, and huangjing. This formula is made up of: 10 g poncirus trifoliata (shichiao), 12 g salvia (danshen), 12 g polygonatum (huangjing), 6 g glycyrrhiza, 12 g lyceum, digupi, 10 g anemarrhena (zhimu), 10 g ophiopogon maimendong (maimendong), 20 g peony, and 15 g rehmannia.

Add 15 g amyda (biejia) and 15 g artemisia (chinghao) for recurrent fever and restlessness. Biejia needs be decocted first.

If there is also hemoptysis and coughing, add 15 g equus (ejiao), 10 g fritillaria (beimu), 10 g lillium (baihe), and 10 g schisandra. You need to dissolve ejiao in the finished decoction.

For heart palpitations, insomnia, and restlessness, add 15 g polygonum multiflorum (yejiaoteng) and 12 g biota (baiziren).

Blood Stasis and Qi Stagnation

Main Symptoms: Secondary amenorrhea arises in the patient along with subcostal distending pain, chest pain, irascibility, agitation, depression, and lower stomach pain with guarding. The pulse is impeded and taut or taut and deep, while the tongue is speckled with purpuric spots or cyanotic.

Plan of Treatment: Unblock the meridians, remove stasis, move blood, and regulate Qi.

Treatment: Releasing Blood StasisDecoction (Hsue Fu Zhu Yu Tang).

Add 15 g aucklandia (muhsiang), 10 g citrus tangerine, 10 g curcuma (ezhu) if Qi stagnation is more serious than blood stasis, with lower stomach and subcostal distention, and marked chest.

Add 10 g sparganium (sanleng), and 10 g curcuma if blood stasis is more severe than Qi stagnation.

Phlegm-Dampness Accumulation

Main Symptoms: The patient suffers from secondary amenorrhea along with a rise in vaginal discharge that is viscid and white. The patient typically has generalized edema or is obese. There are also epigastric and chest tightness, shortness of breath, heart palpitations, blurry eyesight, dizziness, flexed limbs, and lassitude. The pulse is slippery while the tongue is plump and pale, with greasy and white coating.

Plan of Treatment: Regulate menstruation, move blood, and remove Dampness and Phlegm.

Treatment: Decoction of Atratylodes-Poria Phlegm-Dissipating (Augmented Cang Fu Dao Tan Tang) – see treatment for Phlegm-Dampness resulting in abnormal menstruation.

Cold in Blood Resulting in Blood Stasis

Main Symptoms: Besides secondary amenorrhea, the patient suffers from cold pain in the lower stomach, with guarding. Warmth alleviates the stomach pain. The patient has a pallid complexion and her limbs and body are cold. The pulse is tight and deep while the tongue is bluish and a white coating.

Plan of Treatment: Regulate menstruation, move blood, remove Cold and warm the meridians.

Treatment: Meridian-Warming Decoction (Wen Jing Tang) – see treatment for Cold in the blood resulting in abnormal menstruation due to strength.

If the limbs are cold, add 12 g of processed epimedium (yinyanghuo ) and 8 g aconitum (fuzi).

If is there is severe lower stomach cold, add 10 g curcuma, 8 g feniculum vulgare aiye (hsiaohuihsiang), and 10 g artemisia.

Acupuncture Treatment

For strength type amenorrhea, choose the acupoints LR 2 (Hsingjian), SP 6 (sanyinjiao), SP 10 (Hsuehai), LI 4 (Hegu), and RN 3 (Zhongji).

For deficiency type amenorrhea, choose acupoints ST 36 (Hsusanli), RN 6 (Chihai), BL 23 (Shenshu), and BL 20 (Pishu).

Christina Prieto, AP
1617 Hillcrest St
Orlando, FL 32803
Phone: 407-234-6454

Written by Valerie

April 25th, 2017 at 11:55 pm

Posted in Acupuncture

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